Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast brought to you by Riverside HealthCare. I'm your host, Gabby Cinnamon, and today I'm very excited to be joined by Dr. Faizan Bader, a Podiatrist at Riverside, to talk about common foot and ankle injuries and how to prevent them.

Thank you so much for coming on the podcast today, Dr. Bader.

Thank

Faizan Bader, DPM: you for having me.

Host: So this is your first episode with us.Can you tell us a little about yourself, your training, your background, all that?

Faizan Bader, DPM: Sure, yeah.I grew up in the southwest suburbs of Chicago. I did most of my training out on the east coast. Went to school at Temple University, for podiatry school, and thenI trained out in Edgewater, New Jersey. I've been in the community here at Riverside for about two and a half years. Previous to this, I was, working in the city of Chicago. So, happy to be back.

Host: Awesome, well we're very excited to talk to you today. In my research for this episode, I found that there's actually a lot of different things that can go wrong with your feet and ankles. What are some of the most common foot and ankle injuries that you see in your clinic?

Faizan Bader, DPM: Yeah. So as far as, you know, sports medicine and, you know, if you, if you're, if you're talking about like trauma, we see metatarsal fractures, we see toe fractures, we'll see heel pain. Of course we'll see the ankle sprains and the fractures as well.

Beyond that, of course we're doing a lot of diabetic foot care, and we're working on a lot of chronic conditions of the foot as well.

Host: Wide array of things for sure. So there are some injuries that we'll kind of have you elaborate on some common ones. The first one that I wanted to talk about was stress fractures. So what is a stress fracture and how do you know if you have one?

Faizan Bader, DPM: Yeah, so a stress fracture is characterized by repetitive maximal loading on a certain bone in the foot, if we're talking about the foot and ankle, right? Unlike traditional fractures where they're very discernible on x ray; these fractures are not. So, it can be sometimes kind of a vague picture and we have to kind of sort through that and make sure the patient knows that they have a stress fracture.

Host: So you mentioned, you know, like a maximal load on your feet or ankle I should say, causing these stress fractures. Do certain activities cause them, or are more likely to cause them than others?

Faizan Bader, DPM: Yeah, you know, the studies really show that most of the patients that come in with, I can't really speak of other, you know, as far as like the femur or the tibia, uh, but as far as the foot bones are concerned, running is, pretty much the biggest type of risk factor you can say, or any type of likehigh intensity sport with lateral movements, basketball, volleyball, etc.

Host: So, you know,let's say someone listening to this is like, Oh my gosh,I love to run and I don't want to stop running, or I love doing this activity. How can you continue to do those activities and try and prevent these injuries, like a stress fracture from happening?

Faizan Bader, DPM: That's a good question. Most of the time, when we have a patient come into the clinic and they do have a stress fracture, it's like a first time occurrence, right. We have to obviously diagnose them, get the imaging, and make sure they're offloaded, or, or, you know, if they're a surgical patient, we have to talk to them about that. After you have a stress fracture or you havea certain foot type, we can guide you through what can be done, whether that be physical therapy, foot and ankle conditioning, or orthotics is big, to kind of offload that area to make sure you don't, get that stress fracture into kind of a worse state. Of course, stress fractures can become fractures, frank fractures. So we want to avoid that.

Host: Does footwear play a role in any of that? I just wonder, I'm into running and so I like read all these different things and it's like,

 does that really make a difference?

Faizan Bader, DPM: It definitely does. I mean, like from like the 80s, 90s, 2000s till now, there's been like different theories on like, what's the best type of footwear to run in. And, you know, there's from like, maximal kind of cushioning of the heel to, you know, barefoot kind of the, the new trend over the last like five, 10 years, just like this barefoot running. So the verdict is out, but you know, ill fitting shoes, shoes that actually do not fit you, and or, you know, like high heels or like super flat shoes, consistently over like five to ten years is definitely putting you at risk, to get a stress fracture.

Host: Got it. That makes sense. So you had mentioned possibly surgery as a treatment. I guess, can you kind of go through what treatment for a stress fracture might look like if someone comes in and they end up having one?

Faizan Bader, DPM: Yeah. Stress fractures can range from an acute, a subacute, and a chronic really, so if we can have patients come into clinic and it's very like kind ofearly in the game, we can get them offloaded. We can get them to really be non-weight bearing for a certain amount of time, get our serial imaging, and just kind of make sure it heals that way,

There are certain things that other doctors may not really talk about as much, and that would be diet, nutrition, and that component of it as well.

Host: So kind of switching gears a little bit, the next injury I was hoping you could talk to us about is Achilles injuries, like a sprain or a rupture. Can you kind of explain what that is and how that happens?

Faizan Bader, DPM: Yeah, so Achilles injuries, we can kind of characterize as, acute and then like are chronic. So if somebody has like an Achilles rupture, that's usually when the foot is plantar flexed. So it's all the way down kind of in the tippy toe position. And if someone were to dorsiflex and really prop up that foot with a certain amount of force, that's enough force for an Achilles to reallyrupture.

That's acute, Achilles rupture. And of course it has grades, etc. Tendinitis is a little bit tougher. I mean, there's all these parameters people have as far as BMI and the overall health condition that can lead to an Achilles tendonitis. Less severe, more of a inflammatory response of the tendon.

Host: Interesting. I feel like, of like the different injuries that I hear about, people say like Achilles is one of the worst ones. I'm not sure if it's just people I've talked to, like, they're like, it happened so suddenly, or, you know, I didn't it see it coming, that kind of thing. And then they're just like down for the count for a long time before they can get back to sports and stuff.

Faizan Bader, DPM: I still remember watching Kobe Bryant actually rupture, you know, RIP, rupture his Achilles and he, the recent documentary that I watched, he ruptures his Achilles and he kind of knows about it too at that time. I mean, he's well aware and the trainers are well aware too, and he goes out and he actually, shoots two free throws and he makes both of them.

Of course, he ends up getting surgery. And even with the most advanced techniques and all that; it took him a while to really get back to his form. So, Achilles ruptures, of course, if it's more severe, that's a no brainer, it's going to take longer, but these, athletes and, kind of like non athletic people will usually be back to their norm with aggressive physical therapy, et cetera, in about a year. Yeah,

 about a year.

Host: Wow. Not trying to scare people listening, just something I always, I remember hearing story of someone who like was on like a club volleyball team or something and they're like, I just jumped up and all of a sudden, and the person, that person was kind of familiar with this stuff too and knew like right away it was their Achilles and I was like, that's very scary.

Faizan Bader, DPM: Yeah,I believe it's the strongest tendon in the body. I may be wrong about that, but the heel cord, that's why it's called Achilles, right? So.

Host: Wow. So is there anything you can do to prevent Achilles injuries?

Faizan Bader, DPM: Yeah, foot and ankle conditioning, eccentric exercises, and really mobilizing your Achilles tendon to your maximal capability. Everybody has a different height, different weight, different health status. Where are they in their health status, right? So, if you just, have a routine before physical activity or if you have a routine on a day to day basis, you've had maybe a tendonitis before or you've had a rupture before; you kind of know that stretching it out and really wearing the right shoes is the way to go.

Host: Awesome, great advice. We're going to take a quick break to talk about primary care at Riverside. Riverside knows that health is your greatest asset, and having a primary care provider you trust to join you on your health journey is important to make sure that you are the healthiest version of yourself. If you do not have a primary care provider or are looking for a new one, good news, Riverside has a team of primary care providers. To see a complete list of Riverside primary care providers, visit riversidehealthcare.org/primarycare.

Now back to our episode with Dr. Bader. So what are the treatment options available to patients for, with Achilles injuries? Is surgery always necessary? Kind of what does that look like?

Faizan Bader, DPM: Yeah, so, recent studies will really indicate, a lot of non-operative and early rehabilitation and aggressive PT, which is somewhat surprising. Sometimes we will look at an MRI and think this person needs surgery, and that's not always the case. So, of course, there's a conservative route of casting, and then physical therapy, and then, there's a surgical route of really bringing that tendon back together. Also, there are some new techniques that are minimally invasive for Achilles rupture, so those are kind of indicated for patients that won't be able to necessarily take a whole open approach.

Host: Oh, wow. Good to know people have options available for sure. for Yep. So, kind of, we're going to switch injuries. Another foot injury that I hear a lot about is, plantar fasciitis. Can you explain what that is?

Faizan Bader, DPM: Plantar fasciitis in the podiatry world is like really, really common, and of course like in a general practice type setting that we're here today at Riverside, I mean we see patients with plantar fasciitis probably, and I would say five to ten times a day, right? So it's an inflammation of the fascia, of the tissue on the bottom of your foot. Something you've been walking and running on since you were about two to three years old, right? So.

Host: Are certain people more susceptible to getting plantar fasciitis?

Faizan Bader, DPM: We see plantar fasciitis in all sorts of people. Butthe athletic, I would say more so, are patients with higher BMIs or are patients with comorbidities. They're kind of more susceptible. Um,there are definitely some studies talking about diabetic patients who end up getting plantar fasciitis at a higher kind of rate.

Host: So what treatments are available for plantar fasciitis and like does it every go away or is it something that you just kind of manage I guess?

Faizan Bader, DPM: Yeah, there's this misnomer where like plantar fasciitis does not away. I, I don't, not, not, not in my world. I, I really hope like that's not the case because we work pretty aggressively, of course, again, the stretching, the home stretching program and all that, but, we also offer steroid injections into the heel. So, in my practice, we will do one to two steroid injections in a year. If that's not taking care of it, then, we go to minimally invasive surgery. A big thing with plantar fasciitis is also a good orthotic. Some people are in good shoes, and they're still kind of dealing with this plantar fasciitis, they just need to be propped up into an orthotic, they need that arch support.

Host: Talking about all of these injuries overall. You talked about footwear with stress fractures. Can you kind of reiterate again, like the role that the right proper footwear plays in preventing these injuries and kind of how to know if you're wearing the right shoes for you?

Faizan Bader, DPM: Yeah. You yourself will be able to tell kind of like a fatigue factor and I'll just take my own example. I was wearing the shoes that, I want to wear, I like to wear, right? Like Jordans or, Nike's, etc., and nothing against those companies, but, I recently, over the last six months, myself just changed into a better shoe and I found that although I don't have any kind of acute foot or ankle problems, I found at the end of the day, that foot fatigue is kind of gone, right?

So I think that's kind of like you yourself will be able to kind of tell. Of course if you're in a specific sport or you're a specific kind of like body type, well, what I say is go to these specialty stores, go to the New Balance store, right? Or like, go to these like running stores because these people working there will really kind of fit you for shoes.

It's hard to, you know, go on Amazon, go to these stores and likebuy things online, and then they're not fitting. And then all of a sudden, you've just, you're in a situation where you're at the doctor's office, you can't do the things you want to do.

Host: Yeah, I feel like sometimes too, like a friend, like who's into running or something like, Oh, I really like these and then I'll try them and they're like awful. And I've just spent you know, this much money on these shoes they do not work for at all.

Faizan Bader, DPM: Yeah, it's not,it's not cheap but, you know,it's worth it.

Host: So what are your best overall tips for preventing foot and ankle injuries? You know, are there common causes that you see in the clinic for all of these? What's in people's control and what's out of their control?

Faizan Bader, DPM: Yeah, I mean, there's definitely some intrinsic factors and there's extrinsic factors. The intrinsic factors, of course, are a little bit tough to manage, like, right away, of course, you know,I have a patient that's type 2 diabetic and his blood sugars are way out of control and everything is tight in the foot and the ankle and they're having generalized pain or if they have arthritis and this has been going on for the last 10 years, that's one thing.

But if you can kind of compensate that with a good routine, if you can compensate that with at least getting into the podiatrist's office, you know, getting the imaging and just getting advice on like, is this a good shoe? Is this a good fitting orthotic? There's a lot of over the counters now on the market. Not everyone needs a custom, made orthotic. Although there are conditions where some people do. So yeah, just like having that awareness in general, will kind of prevent you from seeing me, right?

Host: That makes, that make sense.

Faizan Bader, DPM: For the most part. For the most part yeah.

Host: Before we go, is there anything else you would

Faizan Bader, DPM: Yeah, just we go to piggyback off that last statement, if you're in the community, and we see this all the time, where things start off kind of small, and could be said with is that lot of pathologies, a lot of musculoskeletal stuff as well, and if it's, you know, sometimes we just, busy lives, you know, everyone's very busy andeveryone just doesn't have time to make an appointment or, just thinks that, there's nothing to this, it's just a strain, it's just, this, you know, and if it is a stress fracture, you're just kind of sitting on it, right?

Or standing on it. So, you feel like something's wrong and, it's really affecting your activities of daily life, come in and at least, get an eval. Andbecause there's so many cases where, we've almost prevented people from getting into situations or, you know, if you have a 5k coming up or, you know, if you're before the summer, people have come in and they're like, okay, I'm going on vacation.

I'm going to be walking like 30,000 steps in Disney, like, what do I do? Likethis hurts, you know, so we can, work it out and work through those kind of questions.

Host: That's a great, statement to leave everyone with, because I think a lot of times, yeah,we think, oh, well, this will go away, unfortunately things can just get worse and a lot of times they don't just go away. So definitely make an appointment with a podiatrist.

Faizan Bader, DPM: Yes, yes, yes.

Host: Well thank you so much, Dr. Bader for coming on the podcast today.

Faizan Bader, DPM: Thank you for having me. Appreciate it.

Host: And thank you listeners for tuning in to Well Within Reach, brought to you by Riverside Healthcare. Make sure to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you listen to the show. To learn more about podiatry at Riverside, visit RiversideHealthcare.org.